Outcomes of acute kidney injury in critically ill children who need renal replacement therapy.

Aim To determine an outcome of acute kidney injury (AKI) in critically ill children (CIC) who needed renal replacement therapy (RRT) and were admitted to the Paediatric and Neonatal Intensive Care Unit (PICU and NICU) at the Paediatric Clinic, University Clinical Centre Sarajevo (UCCS). Methods The research included 81 children with AKI. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI was used. Other laboratory findings and imaging tests were made depending on children's primary disease that led to the AKI. Results Among 81 children with AKI, 38 were girls and 43 boys. A total of 39 (48.1%) patients died; the death was due to the nature of the primary disease and multiple organ failure syndromes. Out of the total of 81 patients the highest mortality rate was found in children in the first year of life, 22 (56.4%), while 17 (43.6%) patients died after the first year of life. Conclusion Without an accurate diagnosis at the right time, due to the lack of adequate biomarkers for AKI screening, the heterogeneity of AKI, comorbidities often lead to unfavourable outcomes of the disease, among CIC, especially in infants with low birth weight and extreme immaturity. Some causes of AKI are preventable and can be reduced by a better organization of primary and secondary health care.

Prognostic value of colour Doppler brain sonography for the neurodevelopmental outcome in term neonates with hypoxic ischaemic encephalopathy.

Aim To determine a prognostic value of cerebral blood flow parameters for the development of neurological sequelae in term neonates with hypoxic ischaemic encephalopathy (HIE). Methods We reviewed medical records of 47 term neonates with HIE who survived until the age of 12 months of life. According to the Sarnat and Sarnat clinical score, neonates were divided into 3 groups: mild HIE, moderate HIE and severe HIE. All included neonates had the colour Doppler brain sonography performed in the first 24 hours of life. The neurological assessment was done at the age of 12 months of life by using the Denver Developmental Screening Test (DDST). Logic regression analysis was performed using the colour doppler brain sonography parameters with the development of neurological impairment as the primary outcome. Results Out of 47 neonates, 19 (40.4%) were with mild, 17 (36.2%) with moderate and 11 (23.4%) with severe HIE. The values of cerebral blood flow parameters and resistance index (RI) significantly correlated with the neurological impairment at the age of 12 months of life (p<0.001). The limit value of RI indicating the poor neurodevelopmental outcome was 0.81, sensitivity 80%, specificity 85.3%, positive predictive value 52.2% and negative predictive value 95.2%. Conclusion The cerebral blood flow parameters measured with colour doppler brain sonography are good indicators of the severity of HIE and later neurodevelopmetal outcome.

Postasphyxial renal injury in newborns as a prognostic factor of neurological outcome.

OBJECTIVE: To estimate if an acute postasphyxial renal injury in newborns could indicate a neurological outcome. METHODS: We conducted a prospective clinical trial on 50 full-term newborns with 5-minute Apgar score <7 (asphyxiated group) and a control group of 50 full-term newborns with 5-min Apgar score ≥ 7 (non-asphyxiated group). Renal function was assessed on the third day of life by serum values of creatinine, cystatin C and ß2-microglobulin (ß2M) and glomerular filtration rate (GFR). All newborns had brain and renal ultrasonography at early stages and were followed by Amiel-Tison Neurological Assassment (ATNA) throughout the first year of life. RESULTS: Mean GFR was significantly lower in asphyxiated than in non-asphyxiated group (22.08 ± 6.66 ml/min/1, 73 m(2) versus 35.42 ± 2.26 ml/min/1, 73 m(2); p < 0.001) and serum values of creatinine, cystatin C and ß2M were significantly higher (1.13 versus 0.66 mg/dl; 3.92 versus 1.52 mg/l; 1.53 versus 0.99 mg/l; p < 0.001). In asphyxiated group ATNA results throughout the first year of life significantly correlated with renal function (p < 0.01). A correlation of ATNA with Apgar score at 5 min, Sarnat and Sarnat staging of hypoxic ischemic encephalopathy and brain and renal ultrasonography has also been significant (p < 0.01). CONCLUSIONS: Our study showed a significant correlation between early impairment of renal function due to neonatal asphyxia with neurological outcome at the end of the first year of life.

Sepsis in premature newborns with congenital heart disease.

OBJECTIVE: To determine the incidence and distribution of neonatal sepsis in premature newborns with congenital heart disease (CHD) according to gestational and postnatal age, time of onset, and type and frequency of causing agents, and compare it with premature newborns without CHD. DESIGN, SETTING, PATIENTS: A clinical investigation on 80 premature newborns admitted to neonatal intensive care unit (NICU) of Pediatric Clinic University Medical Center Sarajevo, Bosnia and Herzegovina, between October 23, 2007 and March 18, 2009. We analyzed the incidence and distribution of neonatal sepsis in premature newborns with CHD according to gestational and postnatal age, time of onset, and type and frequency of causing agents, and compared it with premature NICU patients without CHD. RESULTS: Of the 80 premature newborns included in our study, 14 had CHD with patent ductus arteriosus as the most common type of anomaly. Culture-proven sepsis was diagnosed in 28.57% premature newborns with CHD and 12.12% premature newborns without CHD. The three most common causing agents were Staphylococcus aureus, Klebsiella species, and Serratia species. CONCLUSION: Premature newborns with CHD have a higher risk of acquiring sepsis during hospitalization in NICU, probably because of longer duration of hospitalization and need for invasive procedures such as mechanical ventilation, central venous catheters, and parenteral nutrition.